Case Report
Case study of R hinosporidiosis in tertiary care centre
S Kalyani 1, R Uma 2*
1Associate Professor, 2Assistant Professor, Department of Pathology, Government Thiruvarur Medical College, Thruvarur, Tamil Nadu, INDIA. Email: [email protected]
Abstract Rhinosporidiosis is a chronic granulomatous inflammation caused by Rhinosporidium seeberi which is endemic in India but also reported in other parts of the world. A study was done at Department of Pathology, Government Thiruvarur Medical College, Thiruvarur district from Jan 2015 to Dec 2015. The case study included 65 cases of nasal mass.of these 65 cases, 25 cases were reported as rhinosp oridiosis by HandE stained section. Special stains like GMS and PAS were done. Keywords: Rhinosporidiosis, nasal mass, special stain, Thiruvarur district.
*Address for Correspondence: Dr. R. UMA, Assistant Professor, Departme nt of P athology, Government Thiruvarur Medical College, Master plan complex, Vilamal, Thiruvarur, Tamil Nadu 610004, INDIA. Email: [email protected] Received Date: 12/12/2015 Revised Date: 07/01/2016 Accepted Date: 10/02/2016
Access this article online MATERIALS AND METHODS A retrspective study was done for one year from Jan 2015 Quick Response Code: to Dec 2015 in the Department of Pathology, Government Website: Thiruvarur Medical College, Thiruvarur district. The
www.medpulse.in biopsy samples were received from the department of
surgery and ENT of the Government thiruvarur medical
college. A histopathological study of 65 cases with nasal
masses were done. of these 65 cases,25 cases were DOI: 22 February
diagnosed as rhinosporidiosis. The cases were diagnosed 2016 on H and E stained section. special stains like GMS and
PAS were also done. Relevant clinical details and
INTRODUCTION laboratory investigations were collected from the Rhinosporidiosis is a chronic granulomatous hospitals. inflammation commonly affecting the mucous membrane of nose, nasopharynx and eye 1.other rare sites include RESULTS lips, palate, uvula, conjunctiva, skin, larynx, trachea, During the one year of study, rhinospo ridiosis accounted penis, vagina and bone 2. The causa tive organism is for 38.5 % of all nasal masses in our institution. All cases Rhinosporidium seeberi, first described in 1900 by were confirmed histopathologically. Patients presented Guillermo seeberi 3. Majority of cases are reported in with symptoms of nasal obstruction. Age of the patients India and srilanka 4. Mode of spread is from dust and included in this study ranged from 4yrs to 60yrs. The disease presented commonly in 2 nd decade 32% followed stagnant water sources like wells, ponds and tanks in st rd endemic areas1. Most cases presented as nasal by 1 and 3 decade with 16% each. There were 14 males obstruction and epistaxis due to the friable polypoid mass 56% and 11 females 44% with M: F ratio of 1.3:1 having in the nasal cavity 5. In our country certain parts like male preponderence.
Thanjavur, Madurai, Kanyakumari of Tamil Nadu, Table 1: Nasal masses Allepey, Kottayam, Trivandrum districts of kerala are Sr. No of Nasal Masses Percentage endemic to rhi nosporidiosis. Here we are presenting the No. Cases incidence of rhinosporidiosis in Thiruvarur district. 1 Allergic nasal polyp 28 43.08% 2 Rhinosporidiosis 25 38.5% 3 Aspergillus infection 2 3.08% 4 Mucor 1 1.53%
How to site this article: S Kalyani, R Uma. Case study of Rhinosporidiosis in tertiary care centre . MedPulse – International Medical Journal. February 2016; 3(2): 231 234. http://www.medpulse.in (accessed 28 February 2016). MedPulse – International Medical Journal, ISSN: 2348 -2516, EISSN: 2348-1897, Volume 3, Issue 2, February 2016 pp 231 -234
Lobular capillary 5 1 1.53% hemangioma AGE WISE DISTRIBUTION OF CASES 6 Rhinoscleroma 4 6.155 7 Hemangiopericytoma 1 1.53% 8 Inverted papilloma 2 3.08% 9 Squamous cell carcinoma 1 1.53%
Table 2: Sex distribution 8 Male Female 4 CASES 14 [56%] 11[44%] 4 3 3 3 Table 3: Age wise distribution in decades 1ST Decades No of cases Percentage 2ND 3RD ST DECADE 4TH DECADE DECADE 5TH 1 4 16% DECADE 6TH ND DECADE 2 8 32% DECADE 3RD 4 16% TH 4 3 12% Figure 3: Age wise distribution of cases TH 5 3 12% 6TH 3 12% DISCUSSION
Rhinosporidiosis seeberi is a member of the phycomycetes class of fungi2. It was first reported by NASAL MASSES Malbran 1892 described as a protozoan by Guellermo seeberi in Argentina1900 and as phycomycetes by Ashworth 1923. 6,7 Finally it was placed in mesomycetozoa(group related to fish pathogen) by Heer 28 25 et al in 1999. 8reconfirmed by Friedericks et al in 2000. 9 In India the highest incidence is seen in costal areas 2 1 4 1 1 2 1 NO OF CASES especially Tamilnadu and also West Bengal. 10,11 in this study, among 65 nasal masses, 25 cases (38.5%) were rhinosporodiosis. Global distribution of rhinosporidiosis in different continents was published in 1949is is in table 4. TABLE 4 12 :
Figure 1: Nasal masses Continent cases Africa 12 America 50 Europe 3 Asia 377 India 233 Total 422 MALE 44% 56% Comparison done between total cases and duration of FEMALE study from various authors in table 5. Of which our study is for 1 year and the cases include 25 nos. David et al reported 100 cases in 2 years study, Makannavar et al reported 34 cases in 11.5 years. Table 5. 13,14,15,16,17,1
Duration of Author Total cases study in years Figure 2: Sex distribution Kutty et al (Kozhikode)(1963) 52 10
David SS(Tirunelveli)(1969) 100 2 Dube and Veliath(Mangalore)(1964) 27 7 Das et al (West bengal)(1964) 57 12 Makannavar et al (Karnataka)(1998) 34 11.5 Ahmed et al (Malappuram)(2012) 54 3.5 Our study (Thiruvarur )(2016) 25 1
MedPulse – International Medical Journal, ISSN: 2348-2516, EISSN: 2348 -1897, Volume 3, Issue 2, February 2016 Page 232 S Kalyani, R Uma
In our study the common age group involved is between limited to surface epithelium of nasal mucosa but rarely 11 to 20 yrs. Ahmed et al and Ranjan kumar guru et al wide dissemination with cutaneous or visceral reported cases between 21 to 30 years of age group. involvement can occur. 19,20 The common symptom is nasal mass and nasal obstruction. The nasal lesion usually Table 6: Age wise distribution of cases starts as a small papule that grows into a polypoidal mass (0 -10) (11 -20) (21 -30) (31-50) Above 50 Authors Total causing obstruction of the nose. cutaneous lesion often yrs yrs yrs yrs yrs start as a friable papilloma that become pedunculated. 21 Ahmed et - 12 24 14 4 54 Histopathologically many round thick walled cysts al Ranjan (sporangia) up to 0 5mm in dia with endospores (6 7µ in kumar guru 10 81 91 53 7 242 dia) in different stages of maturation is present. The et al surrounding tissue has inflammatory reaction. These Our study 4 8 4 6 3 25 spores are positive for PAS (Periodic acid Schiff) and GMS (Gomoris methanamine silver) stain. In cytology In this study, slight male preponderance is seen. Ahmed 10% KOH and pap stains are used. 22 in our study PAS et al and Ranjan kumar guru et al also reported male and GMS stains are used to stain the spores. Several preponderance. comparision between sex preponderance modes of spread have been postulated for cutaneous in various studies done in table 7. rhinosporidiosis like direct inoculation or auto innoculation through traumatized epithelium and Table 7: subsequent hematolymphoid spread. 23 Disseminated Authors Male female Total cutaneous rhinosporidiosis with nasopharyngeal Ranjan kumar guru et al 168 74 242 19,20,23,24 Ahmed et al 39 15 54 involvement has been reported by some authors. Our study 14 11 25 Inspite of recognition, rhinosporidiosis remains high risk of recurrence and occasional widespread with fatal Thus the sex ratio is 1.3:1 in this study. Nazia et al complications. 25 surgical removal and electrodessication reported 2.6:1, chitravel et al 18 reported 4:1 to 9:1.The remain the cornerstone of therapy. 23,26 Dapsone has been fact that females have less chance of animal contact, less found to have antirhinosporidial effect by arresting the frequent pond baths leads to lesser female prevalence. maturation of the sporangia and promoting fibrosis in the some authors thought that effect of estrogen in female stroma. 27 provides protection from the disease. 1 Rhinosporidiosis is
Figure 4 Figure 5 Figure 6 Figure 7 Legend Figure 4: Scanner view (5x) of Rhinosporidiosis showing sporangium in the epithelium Figure 5: Low power view (10x) of Rhinosporidiosis sporangium Figure 6: Rhinosporidiosis sporangium stained by PAS (PERIODIC ACID SCHIFF) stain. Figure 7: Rhinosporidiosis sporangium stained by GMS (GOMORI’S METHANAMINE SILVER) stain
CONCLUSION REFERENCES The case study is presented to highlight the higher 1. Nazia Aziz Ahmed RHINOSPORIDIOSIS: AN incidence and endemicity of rhinosporidiosis among nasal EPIDEMIOLOGICAL STUDY, Journal of Evolution of masses in Thiruvarur district and health awareness among Medical and Dental Sciences/ Volume 2/ Issue 38/ September 23, 2013 common people for prevention, early diagnosis, treatment 2. Ranjan Kumar Guru, RHINOSPORIDIOSIS WITH and decreasing reccurence rate after surgery of this SPECIAL REFERENCE TO EXTRA NASAL disease. PRESENTATION, J of Evolution of Med and Dent Sci/
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